Samenvatting

Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in the active individuals, more to female than male in outpatient setting. It is caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint. The aetiology is not known, but possible risk factors include overuse, trauma, muscle dysfunction, tight lateral restraints, patellar hypermobility, and poor quadriceps flexibility, weakness of quadriceps especially vastus medialis oblique. Typical symptoms include pain behind or around the patella that is increased with running and activities that involve knee flexion. Findings in patients with PFPS range from limited patellar mobility to a hypermobile patella. A thorough patient history is needed to find out the mechanisms of the injury, pain characteristics, and to rule out other similar pathologies around the knee. A complete examination of the knee, including a careful assessment of the patellofemoral joint, should be performed such examination may include, inspection, palpation, AROM and PROM, functional tests, resistant tests and clinical tests. The examination should aim to identify features that may alter patellofemoral mechanics. Patellofemoral pain syndrome is diagnosed via the set of characteristic symptoms outlined above. The physical exam will reveal painful kneecap movement or tight and weak structures around it. A well-structured rehabilitation program is the mainstay of treatment. Several studies have shown physical therapy to be effective in treating PFPS. However, there is no one program that will be effective for all patients. The rehabilitation program should focus on correcting maltracking of the patella by addressing the findings identified on the physical examination. Some patients may require significant strengthening of the quadriceps. Others may have excellent quadriceps strength but excessively tight lateral structures or poor quadriceps flexibility. Soft tissue techniques and flexibility exercises can be helpful for these patients. A detailed assessment of the imbalances of patellar tracking is therefore essential to tailoring treatment. Specific exercises can then be prescribed as part of a home rehabilitation program. Studies have shown that a combination of treatment could be helpful as there is no “golden standard” in the treatment tools. It may take weeks or months of treatment for the pain to go away (about 6-12weeks). Most people with PFPS do not need to have surgery. Surgery should be considered only after failure of a comprehensive rehabilitation program. Educating patients about modification of risk factors is important in preventing recurrence. There is no strong evidence throughout the study that indicates one assessment or treatment tool as the best. Therefore further research is needed to come up with the best physiotherapy assessment and treatment tools.